title: Unintended pregnancy among HIV positive couples receiving integrated HIV counseling, testing, and family planning services in Zambia.
abstract: OBJECTIVE
  We describe rates of unintended pregnancy among HIV positive couples in Lusaka, Zambia. We also identify factors associated with unintended pregnancy among oral contraceptive pill (OCP) using couples in this cohort.
  
  
  METHODS
  Data were analyzed from couples randomized in a factorial design to two family planning intervention videos.
  
  
  METHODS
  Rates of unintended pregnancy were stratified by contraceptive method used at time of pregnancy. Predictors of time to unintended pregnancy among OCP users were determined via multivariate Cox modeling.
  
  
  RESULTS
  The highest rates of unintended pregnancy were observed among couples requesting condoms only (26.4/100CY) or OCPs (20.7/100CY); these rates were not significantly different. OCP users accounted for 37% of the couple-years (CY) observed and 87% of unintended pregnancies. Rates of unintended pregnancy for injectable (0.7/100CY) and intrauterine device (1.6/100CY) users were significantly lower relative to condom only users. No pregnancies occurred among contraceptive implant users or after tubal ligation. Factors associated (p<0.05) with time to unintended pregnancy among OCP users in multivariate analysis included the man wanting more children, the woman being HIV negative versus having stage IV HIV disease, and the woman reporting: younger age, no previous OCP use, missed OCPs, or sex without a condom.
  
  
  CONCLUSIONS
  Long-acting reversible contraceptive methods were effective in the context of integrated couples HIV prevention and contraceptive services. Injectable methods were also effective in this context. Given the high user failure rate of OCPs, family planning efforts should promote longer-acting methods among OCP users wishing to avoid pregnancy. Where other methods are not available or acceptable, OCP adherence counseling is needed, especially among younger and new OCP users.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00067522.
authors.affiliation: Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia, United States of America ; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.forename: Lisa
authors.initials: L
authors.lastname: Haddad
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.forename: Naw
authors.initials: N
authors.lastname: Htee Khu
authors.forename: Ilene
authors.initials: I
authors.lastname: Brill
authors.forename: William
authors.initials: W
authors.lastname: Kilembe
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Cheswa
authors.initials: C
authors.lastname: Vwalika
authors.forename: Amanda
authors.initials: A
authors.lastname: Tichacek
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
mesh_terms: D015331:Cohort Studies; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003270:Contraceptive Agents; D037001:Directive Counseling / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D016016:Proportional Hazards Models; D012736:Sex Education / Q000379:methods; D013997:Time Factors; D014743:Videotape Recording; D015024:Zambia / Q000453:epidemiology
chemical_list: D003270:Contraceptive Agents